Rupture of internal iliac artery aneurysm presenting as rectus sheath hematoma: case report

Abstract

This report describes a ruptured internal iliac artery aneurysm that presented as a rectus sheath hematoma (RSH). The patient developed abdominal pain and a large, tense lower abdominal wall mass without peritoneal signs. Computed tomography scan demonstrated a massive RSH contiguous with a ruptured left internal iliac artery aneurysm. Hypovolemic shock prompted immediate laparotomy, aneurysmorrhaphy of the ruptured aneurysm, and evacuation of the rectus hematoma. This uncommon presentation of internal iliac aneurysm rupture should caution against a simple diagnosis of "spontaneous" RSH in a patient with a potentially ruptured iliac aneurysm.

Outcomes of open and endovascular repair for ruptured and nonruptured internal iliac artery aneurysms

“…[6][7][8][9][10] Eventual rupture into the rectum, urinary bladder, ureter, and rectus sheath have also been reported. [11][12][13][14][15] Repair of IIAAs is challenging given the anatomy deep in the pelvis, complex branching patterns, and potential injury to adjacent viscera and nerves. The first attempted repair by McLaren in 1913 with proximal ligation resulted in partial cure.…”

Unilateral recanalisation of hypogastric artery after ligation for postpartum haemorrhage treatment.

“…There are some case reports of asymptomatic aneurysms in internal iliac arteries [7, 8]. It should be taken into consideration whether the presence of such an alteration does not indicate the use of stent graft implantation.…”

Bilateral Rectus Sheath Hematoma in Kidney Transplant Patient: Case Study and Literature Review

“…On the other hand, other diagnosis such as rupture in the aneurism of internal iliac artery should be considered for the early diagnosis of RSH (11). In the presented patient, given that the first transplant was performed on the right side, the early diagnosis was probable ruptured aneurism, but it was ruled out in later studies.…”